01 February 2011 ~ 28 Comments

Ask Rash: Misconceptions About Sleep Apnea and The Neurological Effects of Vitamin D Deficiency

Question: I am curious what the biggest misconception is about sleep apnea. And have you found that low Vitamin D is a source of neurological problems?

This seems to be something that many thyroid patients suffer from and are sometimes unaware of. To read more on this topic, check out the comments following Heide’s question in this previous post, as well as Rash’s answer to her in this post. Feel free to post about your own experiences too – it is by sharing that we can learn from each other.

Let’s share our experiences. I’d also be very interested in hearing from those who have been diagnosed with sleep apnea and how they have dealt with/are dealing with it.

First of all, to help you determine if you might suffer from this, Rash would like to ask you the following three questions:

1.    Do you snore at night?

2.    Are you tired during the day?

3.    Do you get up to go to the toilet at night more than once?

Answer:
Sleep apnea is hugely undiagnosed and many providers do not even screen for it, partly because they are very uneducated with regard to this condition. I see an average of 16 patients a day and of the three I screen I can guarantee that at least two of them will have sleep apnea.

Sleep apnea, if left untreated, can lead to pulmonary hypertension (high blood pressure in the lungs), increased fatigue during the day, cardiovascular disease and leg and ankle swelling due to fluid accumulation caused by cardiac valvular malfunction.

The misconception in sleep apnea is that you either have to have a large neck or be obese. [Editor: Lori also mentioned in her comment on the previous post that she didn’t have the classic symptoms of snoring and breathing pauses while sleeping when she was diagnosed with sleep apnea, so that is perhaps another misconception – that it is always associated with snoring]. However, although this is the reason in the majority of cases, it is not always the case. In some instances the individual is slim, but the problem lies within the brain. This is called central sleep apnea. The brain can fail to signal the breathing centre to breathe adequately, leading to a build-up of waste products that should be expelled with breathing. That is why the three questions posted above are always asked of all our clients as you never know.

The anatomy made simple is as follows. If you have a pipe (blood vessel) 5 cm in diameter (these measurements are not actual size), which is a normal width, blood will pass through the lungs and waste gases your body has discarded will be expelled while oxygen replaces the waste and nourishes our whole body and tissues. You need to allow enough time for this to take place.

Now make the pipe 2 cm in diameter. Blood will pass through it so much faster – like when you put your finger over a hosepipe and the jet gets stronger. Due to the faster blood transport, the exchange of both the waste and oxygen becomes inadequate. This eventually leads to increased pressure in the heart as the heart has a hard time pumping against the increased pressure, which will ultimately lead to heart incompetency. This in turns leads to further problems.

So how does this occur you ask? Well, when you sleep, depending on your anatomy, the tongue and oral pharynx (the part of the throat situated immediately behind the mouth and nasal cavity) relaxes, which causes a partial blockage over your entrance to the lungs. When this occurs, you get a lack of oxygen to nourish your body and hence the excessive tiredness during the day. Furthermore, as the pressure increases in your heart, the body thinks your heart is pumping inadequately and releases a natural diuretic which makes you go to the bathroom a couple of times during the night.

This is so easily treated that if you have sleep apnea and use the CPAP ventilation apparatus you will notice a major increase in energy levels, as well as a reduction in heart and lung problems, especially hypertension (high blood pressure). It also allows you to sleep with your significant other without waking them up.

Regarding the Vitamin D and neurological problems: they are still investigating the relationship, but no peer-reviewed research articles have been conducted. However, there are some preliminary studies showing a link between low Vitamin D and an increase in multiple sclerosis, as well as depression and bipolar disorder. To add to that, there is a very strong correlation between low Vitamin D and cardiovascular disease. In fact, a low Vitamin D level has been shown to increase the risk of a heart attack by 1 in 7. Also, remember Vitamin D and calcium are very important while going through menopause. That is another topic however and I am more than happy to address it if anybody is interested.

I hope I have answered your question and am always open to other questions.

NP Rash

As ever, Rash looks forward to your questions and suggestions on topics you would like him to talk more about – please mail me at: sarah@sarahjdowning.com.

28 Responses to “Ask Rash: Misconceptions About Sleep Apnea and The Neurological Effects of Vitamin D Deficiency”

  1. cathy wilson 1 February 2011 at 3:16 pm Permalink

    I know for a fact the sleep apnea is true.. I done a sleep study, because I was having seizures.. and they found that I quit breathing 21 times during one night and had 3 seizures..and O2 went down to 58%. since having the cpap machine and now oxygen with it but the cpcp helps me get a full nights sleep and i have more energy. The instant I put the mask on I go to sleep it’s that relaxing to me.. Thanks for the input on the cpap and sleep apnea…

    • Sarah Downing 1 February 2011 at 3:17 pm Permalink

      Thank you very much for sharing your experiences, Cathy. I’m glad that you are now able to get a full night’s sleep! ZZZZ:-).

    • rash 2 February 2011 at 1:13 am Permalink

      that is bad. we have had patients with as much as 78 times an hour, yes an hour. however when on the cpap machine the energy levels rise so much and they love you for that.

  2. anita 1 February 2011 at 6:21 pm Permalink

    wow. had no idea. i’m always complaining about getting up at nite to go to the bathroom. maybe i’ll have to look into this. thanks rash!

    • Sarah Downing 1 February 2011 at 6:22 pm Permalink

      Oh jeeze, Anita. Do you feel tired during the day? Let me know if you want to ask Rash any more questions about this as it’s one of his favourite topics. He also asked me those three questions when we first met:-). LOL.

  3. lori 1 February 2011 at 9:22 pm Permalink

    Glad you brought up central sleep apnea. I don’t think many have heard of that. In all the years I transcribed medical reports I had never heard of it. I didn’t learn of it until the sleep tech told me that may be a possibility in my case, but it turned out I did not have that type. Surprisingly to me, I did not appreciate noticeable improvement in sleep apnea symptoms until my thyroid was adequately treated. However, the episodes were definitely brought under control with the CPAP machine. One thing I did notice almost right way was that the CPAP virtually eliminated my TMD (temporomandibular dysfunction) pain.

    • Sarah Downing 1 February 2011 at 9:26 pm Permalink

      Hey Lori,

      I thought Rash gave a good explanation too. I must say I always wanted to write about sleep apnea myself, but had been putting it off because I don’t know enough about it. However, I’ve always been aware of the close connection between thyroid disease and sleep apnea, possibly in part because many of us have enlarged thyroids that obstruct our breathing and possibly also because of the weight issues that thyroid disease can cause. I was wondering what temporomandibular meant – for anyone else who was wondering the same: it’s the joint of the jaw, the part that connects your jaw to the side of your head. You learn something new everyday.

      Love,

      Sarah

  4. lori 1 February 2011 at 9:53 pm Permalink

    TMJ/TMD seems to be another common problem with thyroid disease. Because my thyroid was so enlarged (as well as tonsils and lymph nodes) when I first started CPAP treatment and was already having trouble breathing because of it, I couldn’t tolerate the initial pressure setting; it made breathing much more difficult. I remember the pressure causing shooting pain to my ears, and feeling like my heart was going to explode out of my chest from the effort it took to breathe against against the pressure. Well, I haven’t thought of that in about two years. Glad those days are behind me!

    • Sarah Downing 2 February 2011 at 12:03 am Permalink

      That sounds like a freaking nightmare, Lori. This is the first time I’ve really heard of TMJ/TMD and I added a hyperlink to your commment for a good site that explains these conditions (temporomandibular joint/dysfunction) for anyone who is interested in reading more. I’m glad things settle down. So you feel as if it was getting your thyroid balanced that finally got rid of your sleep apnea – very interesting. I’m glad those days are behind you too!

      Love,

      Sarah

  5. rash 2 February 2011 at 1:19 am Permalink

    If anybody would like some info and advice on sleep apnea just let me know and i will be more than happy to help you with the screening. Also, for those who do not know what the CPAP machine does here we go. Pressure is administered through the mask that helps lift the tongue and other obstructions at the back of the neck, ie, an enlarged thyroid, off the wind pipe. When the pressure opens up the obstruction oxygen can get to the boby more easily therefore no more fatigue. in fact the doc I work for also has sleep apnea and he is always saying that he will fight you for his machine, lol.

  6. lori 2 February 2011 at 5:43 am Permalink

    Yeah, it was a nightmare at the time. That’s a good link you found on TMD. I am still using CPAP but will be titrating down soon, so I’ll know as I do this if it’s completely resolved. I’ve lowered the pressure once so far and haven’t had an increase in apnea, which I wasn’t able to do previously so there is improvement, but I’m waiting until my next labs and if I need further adjustment of hormones I will wait until that is done and then try titrating down the pressure further. I check the reading on the machine each morning and that will tell me if I’m having any apnea. I haven’t had any for a while so I’m keeping my fingers crossed it will remain that way as I titrate down further. Hopefully the jaw pain will remain under control as well. I don’t want to rock the boat yet, as things are moving along so well. However, I didn’t use it for a few nights when I was sick recently because of coughing and I did fine, so I’m optimistic I will get off it soon.

    • Sarah Downing 2 February 2011 at 6:23 am Permalink

      Fingers crossed that you have no more apnea – that would be great, Lori! I’m happy to hear that you seem to be feeling so much more balanced these days and that the NDT seems to have helped with so many things too!

      • lori 4 February 2011 at 8:08 pm Permalink

        I’m keeping my fingers crossed but if I still need CPAP that’s okay because not treating it is not an option. Yes, the NDT has made a huge difference and it still amazes me how much better I am doing, considering how sick I was. For me, as you know, diet changes and figuring out which supplements I needed, are also a very important part of the whole process.

        • Sarah Downing 4 February 2011 at 8:44 pm Permalink

          I’m keeping my fingers crossed for you too, Lori. It’s encouraging for others to hear how much the NDT has helped you turn around your health. Do keep us posted!

          Love,

          Sarah

  7. Sarah Downing 2 February 2011 at 6:18 am Permalink

    Hi Rash,

    Thank you very much for sharing that scary statistic – it’s crazy that some people stop breathing 78 times an hour. OMG! I can well imagine that they would benefit from treatment. Thanks also for the explanation of the CPAP. I always wanted to write an article on sleep apnea as many thyroid peeps have it, probably in part because of the swollen thyroid some have and also in part because of the overweight that can be caused by thyroid disease. I’m glad you wrote something about this though because I was putting off writing anything as it would have meant a lot of research. This is a topic that I don’t know as much about because I don’t suffer it myself, although Corey has/does. I think it’s better now since his op, but he still does snore occasionally – not all the time though and not nearly as bad as it was. It’s such a complex and technical topic, but one we should all be aware of, particularly if we are tired during the day as many thyroid peeps are. It’s worth investigating if you feel your thyroid is balanced, but you are still tired.

    Love,

    Sarah

  8. Heide K 2 February 2011 at 8:54 am Permalink

    Rash , thank you so much for such a great answer. I was around three hundred pounds and was actually falling asleep at stoplights. Iv always been stubborn, and fought against anything that might show weakness or that I wasn’t in control, as if anyone has that lol. when I had the sleep study i stopped breathing 160 times an hour. After severe diet and exercises to loose weight unsuccessfully, I had a gastric bypass. after loosing about 30 pounds i stopped using it,probably shouldn’t have. But even having sleep apnia I didn’t fully understand it, and they made me watch vidios and study a workbook. I did like the machine, the humidity and filter made my allergies disappear while I slept.
    Cathy W, wow thats a lot of not breathing, were you aware of the seizures before the study? I am glad you are now on a machine.
    Anita, good luck on scheduling your appointment, I hope it goes well.
    Lori, my heart just aches for all you’ve suffered. why do these awfully things happen to such wonderfully people. How awesome your feeling better. You give me such great hope.

    • Sarah Downing 2 February 2011 at 12:46 pm Permalink

      Thanks for commenting and sharing your experiences, Heide. I can’t believe you stopped breathing that many times an hour – wow! It’s also sad you had to have the gastric bypass before being diagnosed with thyroid disease, but that’s another story. On the other hand, it was interesting what you told me about losing some weight when you were on the CPAP – I think I remember that right. I wonder if this is a common thing.

      Love,

      Sarah

    • rash 3 February 2011 at 3:12 am Permalink

      I am glad you found it interesting. I would not however stop using the CPAP machine as although it is awesome that you have lost so much weight u most probably still have it. The best way to find out is to have another screening study and use it without the CPAP. That will tell you if it is still a problem. Also what machine and mask do you have? There r so many different types. I recommend the Swift FX as it only goes on your nose and leaves your face open. Great for those with claustrophobia. I have attached a pic for you. Let me know id u r in the us and where and I will be more than happy to contact your company and make sure they are getting the job done right. Too many docs not knowing about CPAP or sleep apnea.

    • lori 4 February 2011 at 8:21 pm Permalink

      Heide – I had the same problem falling asleep at stop lights. The sleep study showed I was having apnea 48 times an hour. 160 times is unbelievable! I was nodding off driving short distances, then one Mother’s Day driving home with my son I swerved off the highway three times. Up until that point the doc was not taking me serious how bad this problem was getting but after that I demanded to know what was wrong. That’s when narcolepsy was diagnosed and it took another five years to get the right diagnoses, sleep apnea and Hashimoto’s. I stopped driving for a long time but I was also not metabolizing carbs and this would make me very drowsy too. I had never been able to drive long distances my whole life and it’s taken this long to figure out that was part of the problem. I hope you get tested again ASAP!!!

      • Sarah Downing 4 February 2011 at 8:42 pm Permalink

        That’s a scary story, Lori, but thank God you got diagnosed!

        Love,

        Sarah

  9. rash 3 February 2011 at 3:20 am Permalink

    Here is a website of the new really quiet CPAP machine and Swift FX Mask

    http://www.cpapsales.com.au/

    • Sarah Downing 3 February 2011 at 3:58 am Permalink

      LOL. One of the masks makes the guy look like an elephant! But I’m glad you attached a pic, Rash, because this is the first time I’ve seen this type of CPAP mask and it’s good to know that they don’t have to be too claustrophobic.

      • lori 4 February 2011 at 8:39 pm Permalink

        Sarah, it’s not very romantic is it? LOL But it does the job! Mine is very quiet and doesn’t bother my husband at all. I don’t use that type of mask and had to try a few different types before I found the right one for me. Dealing with the company that supplied the equipment was a bit of a nightmare but I don’t get my supplies from them anymore. You really need to do your homework on the equipment because many HMO type insurance plans in the US have deductibles that have to be met first, only cover a certain percentage of DME (durable medical equipment), or only cover a certain amount per year, and this equipment is very expensive, not to mention replacement parts every so often.

        • Sarah Downing 4 February 2011 at 8:43 pm Permalink

          No, it’s not very romantic, but it does sound like it is very necessary for some people. It sounds like it is so complicated to find the right mask at the right price. It’s good to know that Rash is open for questions if anyone needs any help with this.

          Love,

          Sarah

  10. Donna 5 February 2011 at 9:51 pm Permalink

    Well now I can complicate things even more. When I was diagnosed with follicular thyroid cancer 4.5 years ago my sleeping changed. I started to wake up at 4.30 a.m. and eventually my normal wake up time was 2.30 a.m. I attributed this to anxiety, having cancer scared me, my son was just five years old and I wanted desperately to live. I started to take klonopin (anti anxiety med) immediately after diagnosis but did not see a correlation. I accepted the sleeping patterns and adjusted my life accordingly. In January of 2010 at my annual follow-up I asked my endo if my immune system could have been compromised by the RAI treatment and she thought that the treatment dose of 150 millicents was not enough for that to happen. I explained to her that I was constantly sick and that had never been the case prior to cancer. She did a complete blood count and it showed that I had a high red blood count. She told me that more than likely I was not getting enough oxygen to my brain (hypoxia) and contacted my former PCP to suggest a sleep study. The technician was awesome and thought for sure I had sleep apnea even though I did not snore. In the morning when he woke me up he showed me that I went below 70 for 32 minutes starting at 2.42 a.m. (the same time I woke up every day?). Just when he was coming in to give me oxygen I turned and my oxygen levels went up. He was adament that I get oxygen to sleep with immediately and I did. My sleeping started to get back to normal but I still felt like crap pretty much constantly. I’m convinced that it was my fight or flight waking me up now and it was the klonopin that slowed everything down to a dangerous level. For both surgeries to remove my thyroid my blood pressure was extremely low and I was kept in the hospital overnight. Coincidence? I don’t think so. My blood pressure had always been a little low but that was considered a good thing.

    Fast forward to May 2010 when I finally start thinking a little clearer and realized that what I was reading online from other thyroid patients pertained to me. I contacted my endo thinking for sure I was hypo but it ended up I was hyper, even more hyper than they like for cancer suppression. My thyroid replacement hormone was reduced from 150 to 137 to 125 to 125/112 combo to 112 mcg which ironically is exactly where I started 4 years prior.

    The moral of the story is this: I numbed myself with klonopin for much longer than I should have which caused me to not realize I was having heart palps, etc. The rest of the symptoms I attributed to everything but my thyroid levels. I finally kicked my PCP to the curb and found an internist who buys into the fact that if your thyroid levels are off everything in your world can be as well. I reduced the klonpoin to where I take 1/2 of the lowest dose available when I have hear palps and that is it. Since I have much more knowledge and a clear head I have been able to differentiate what is thyroid related and what is not and I have not been sick at all. No chasing good health, no antibiotics I don’t need and should have never been taking to begin with and a light at the end of the tunnel. Yay!

    My levels are within range now and I feel better than I have in two years, maybe more. Looking back I know understand I was swinging hypo to hyper from the very beginning but since I was only getting my levels checked annually (yes I did say annually and that it not a good thing my friends) noone ever caught it including me. I will now get my levels checked every three months for as long as I need to. I have five scripts sitting here to use when I choose. Now that I am in a better place we will do another sleep study and hopefully I can get off the oxygen and on with my life.

    I thought I should throw this out there in hopes that maybe it pertains to someone else. Please educate yourself, advocate for yourself and don’t just believe whatever a doctor tells you. Sometimes they are unable to put all the pieces of the puzzle together. If not for the sleep study tech it is very possible that I would not be alive right now. Bless him.

    • rash 6 February 2011 at 7:25 pm Permalink

      I am glad u threw your pcp to the curb as you did have all the signs. With low thyroid u feel like u have been hit by a number 9 bus, no energy, feeling depressed and weight gain. On the other side hyper, insomnia, palpitations etc. If you have thyroid problems then u should be checked every 4 months. The first tests I perform with symptoms are TSH, Vit D25 Hydroxy and if your are male I always add on a free and total testosterone.

      Also, alot of providers prescribe sleeping meds to help insomnia without performing lab work first. I order labs then recommend melatonin as it is over the counter, cheap and safe. You already have melatonin in your system so it is natural. Start with 3mg then increase to 6mg if needed. However, it can cause weird dreams.

      Always be weary of the doc that does not listen to you or spends as little time as possible. Look for the doc who listens, waits for you to finish discussing your medical issue, asks how your normal everyday life is and formulates a plan with you not for you.

      This is an interesting fact that many providers forget. I can diagnose you in 1 minute. However, it is normally toward the end of the appointment that the real issue becomes apparent. It takes a while for the patient to warm up sometimes. Listening is the most important skill to have as a provider and if you find one without these attributes then find another. Hope this helps.

      Rash

  11. Donna 6 February 2011 at 8:16 pm Permalink

    Hi Rash,

    I agree 100%. My first appt. with my new internist she spent 45 minutes talking to me with my clothes on and an additional 45 minutes examining me. I felt like it was heaven on earth. We learn as we go. I still have faith in the medical community but I also know that I am my only patient so I have to take responsibility for my care as well. Sometimes the best thing you can do is find another doctor but often when you are so tired and sick the effort is more than you can deal with.

    The last two nights I have had trouble sleeping and it has caught up with me. Today I feel like I felt for three years and the thought of ever having to go back just makes me crazy.

    Thanks Rash. Take care. Appreciate your desire to help others 🙂

    Donna
    So here’s another one for you. When I was my most hyper I started to have perspiration even the I used


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